Condom

A condom is a sheath-shaped barrier device used during sexual intercourse to reduce the probability of pregnancy or a sexually transmitted infection (STI). There are both external condoms, also called male condoms, and internal (female) condoms. The external condom is rolled onto an erect penis before intercourse and works by forming a physical barrier which limits skin-to-skin contact, exposure to fluids, and blocks semen from entering the body of a sexual partner. External condoms are typically made from latex and, less commonly, from polyurethane, polyisoprene, or lamb intestine. External condoms have the advantages of ease of use, ease of access, and few side effects. Individuals with latex allergy should use condoms made from a material other than latex, such as polyurethane. Internal condoms are typically made from polyurethane and may be used multiple times. With proper use—and use at every act of intercourse—women whose partners use external condoms experience a 2% per-year pregnancy rate. With typical use, the rate of pregnancy is 18% per-year. Their use greatly decreases the risk of gonorrhea, chlamydia, trichomoniasis, hepatitis B, and HIV/AIDS. To a lesser extent, they also protect against genital herpes, human papillomavirus (HPV), and syphilis. Condoms as a method of preventing STIs have been used since at least 1564. Rubber condoms became available in 1855, followed by latex condoms in the 1920s. It is on the World Health Organization's List of Essential Medicines. As of 2019, globally around 21% of those using birth control use condoms, making it the second-most common method after female sterilization (24%). Rates of condom use are highest in East and Southeast Asia, Europe and North America.

== Medical uses ==

=== Birth control ===

The effectiveness of condoms, as of most forms of contraception, can be assessed two ways. Perfect use or method effectiveness rates only include people who use condoms properly and consistently. Actual use, or typical use effectiveness rates are of all condom users, including those who use condoms incorrectly or do not use condoms at every act of intercourse. Rates are generally presented for the first year of use. Most commonly the Pearl Index is used to calculate effectiveness rates, but some studies use decrement tables. The typical use pregnancy rate among condom users varies depending on the population being studied, ranging from 10 to 18% per year. The perfect use pregnancy rate of condoms is 2% per year. Condoms may be combined with other forms of contraception (such as spermicide) for greater protection.

=== Sexually transmitted infections ===

Condoms are widely recommended for the prevention of sexually transmitted infections (STIs). They have been shown to be effective in reducing infection rates in both men and women. While not perfect, the condom is effective at reducing the transmission of organisms that cause AIDS, genital herpes, cervical cancer, genital warts, syphilis, chlamydia, gonorrhea, and other diseases. Condoms are often recommended as an adjunct to more effective birth control methods (such as IUD) in situations where STI protection is also desired. According to a 2000 report by the National Institutes of Health (NIH), consistent use of latex condoms reduces the risk of HIV transmission by approximately 85% relative to risk when unprotected, putting the seroconversion rate (infection rate) at 0.9 per 100 person-years with condom, down from 6.7 per 100 person-years. Analysis published in 2007 from the University of Texas Medical Branch and the World Health Organization found similar risk reductions of 80–95%. The 2000 NIH review concluded that condom use significantly reduces the risk of gonorrhea for men. A 2006 study reports that proper condom use decreases the risk of transmission of human papillomavirus (HPV) to women by approximately 70%. Another study in the same year found consistent condom use was effective at reducing transmission of herpes simplex virus-2, also known as genital herpes, in both men and women. Although a condom is effective in limiting exposure, some disease transmission may occur even with a condom. Infectious areas of the genitals, especially when symptoms are present, may not be covered by a condom, and as a result, some diseases like HPV and herpes may be transmitted by direct contact. The primary effectiveness issue with using condoms to prevent STIs, however, is inconsistent use. Condoms may also be useful in treating potentially precancerous cervical changes. Exposure to human papillomavirus, even in individuals already infected with the virus, appears to increase the risk of precancerous changes. The use of condoms helps promote regression of these changes. In addition, researchers in the UK suggest that a hormone in semen can aggravate existing cervical cancer, condom use during sex can prevent exposure to the hormone.

=== Causes of failure ===

Condoms may slip off the penis after ejaculation, break due to improper application or physical damage (such as tears caused when opening the package), or break or slip due to latex degradation (typically from usage past the expiration date, improper storage, or exposure to oils). The rate of breakage is between 0.4% and 2.3%, while the rate of slippage is between 0.6% and 1.3%. Even if no breakage or slippage is observed, 1–3% of women will test positive for semen residue after intercourse with a condom. Failure rates are higher for anal sex, and until 2022, condoms were only approved by the FDA for vaginal sex. The One Male Condom received FDA approval for anal sex on 23 February 2022. Different modes of condom failure result in different levels of semen exposure. If a failure occurs during application, the damaged condom may be disposed of and a new condom applied before intercourse begins – such failures generally pose no risk to the user. One study found that semen exposure from a broken condom was about half that of unprotected intercourse; semen exposure from a slipped condom was about one-fifth that of unprotected intercourse. Standard condoms will fit almost any penis, with varying degrees of comfort or risk of slippage. Many condom manufacturers offer "snug" or "magnum" sizes. Some manufacturers also offer custom sized-to-fit condoms, with claims that they are more reliable and offer improved sensation/comfort. Some studies have associated larger penises and smaller condoms with increased breakage and decreased slippage rates (and vice versa), but other studies have been inconclusive. It is recommended for condoms manufacturers to avoid very thick or very thin condoms, because they are both considered less effective. Some authors encourage users to choose thinner condoms "for greater durability, sensation, and comfort", but others warn that "the thinner the condom, the smaller the force required to break it". Experienced condom users are significantly less likely to have a condom slip or break compared to first-time users, although users who experience one slippage or breakage are more likely to suffer a second such failure. An article in Population Reports suggests that education on condom use reduces behaviors that increase the risk of breakage and slippage. A Family Health International publication also offers the view that education can reduce the risk of breakage and slippage, but emphasizes that more research needs to be done to determine all of the causes of breakage and slippage. Among people who intend condoms to be their form of birth control, pregnancy may occur when the user has sex without a condom. The person may have run out of condoms, or be traveling and not have a condom with them, or dislike the feel of condoms and decide to "take a chance". This behavior is the primary cause of typical use failure (as opposed to method or perfect use failure). Another possible cause of condom failure is sabotage. One motive is to have a child against a partner's wishes or consent. Some commercial sex workers from Nigeria reported clients sabotaging condoms in retaliation for being coerced into condom use. Using a fine needle to make several pinholes at the tip of the condom is believed to significantly impact on their effectiveness. Cases of such condom sabotage have occurred.

==== Use of multiple condoms ("double bagging") ====

"Double bagging", the practice of using two condoms at once, might increase or decrease the risk of sperm leaking through; expert opinions are divided, and it may depend on additional factors. Using two condoms may increase the risk of slippage, though the condoms often become stuck together after use. It may also increase the chance of tearing or breaking if there is friction between the condoms. However, lubricant can be added between the condoms to decrease friction. If multiple condoms are used, an exposure break only occurs if all of the condoms are broken. A literature review in Contraceptive Technology Update recommends that "When clinicians see women and men who have experienced multiple breaks or slippages, it would be wise to encourage them to use two condoms." A literature review by Planned Parenthood concludes that "It seems that there is no evidence-based information to support advising against double bagging. On the other hand, the evidence to support double bagging is limited, but positive. It may be best to advise that if double bagging increases a person's sense of comfort and security, there is no harm in using more than one condom, and there may be benefits." With two latex condoms, heat and friction can cause them to disintegrate; however, layering a lambskin condom and a latex condom can be helpful if one of the partners is allergic to latex. For sex workers, presenting clients with a leading question, such as the choice between one or two condoms, or between a male or a female condom, is often easier than directly requesting that they use a condom, and makes it more likely that a condom will be used. Using multiple condoms, especially more than two, may decrease pleasure, prolong intercourse, and/or cause irritation to a woman's vagina. The use of multiple condoms is a behavioral therapy for treating premature ejaculation, though it is not always sufficient. In summary, the consensus seems to be that using two condoms instead of one usually decreases risk if properly lubricated but increases risk if not, and that using more condoms generally results in less sexual stimulation for men.

== Side effects == The use of latex condoms by people with an allergy to latex can cause allergic symptoms, such as skin irritation. In people with severe latex allergies, using a latex condom can potentially be life-threatening. Repeated use of latex condoms can also cause the development of a latex allergy in some people. Irritation may also occur due to spermicides that may be present.

== Use ==

External condoms are usually packaged inside a foil or plastic wrapper, in a rolled-up form, and are designed to be applied to the tip of the penis and then unrolled over the erect penis. It is important that the closed end or the teat of the condom is pinched when the condom is placed on the tip of the penis. This will ensure that air is not trapped inside the condom which could cause it to burst during intercourse. In addition, this leaves space for the semen to collect which reduces the risk of it being forced out of the base of the device. Most condoms have a teat end for this purpose. Soon after ejaculating and whilst the penis is still erect, the male should withdraw from his partner's body. This to avoid semen seeping from the condom as the penis becomes more flaccid. The condom should then be carefully removed from the penis away from the other partner. It is recommended that the condom be wrapped in tissue or tied in a knot, then disposed of in a trash receptacle. Condoms are used to reduce the likelihood of pregnancy during intercourse and to reduce the likelihood of contracting sexually transmitted infections (STIs). Condoms are also used during fellatio to reduce the likelihood of contracting STIs. Some couples find that putting on a condom interrupts sex, although others incorporate condom application as part of their foreplay. Some men and women find the physical barrier of a condom dulls sensation. Advantages of dulled sensation can include prolonged erection and delayed ejaculation; disadvantages might include a loss of some sexual excitement. Advocates of condom use also cite their advantages of being inexpensive, easy to use, and having few side effects.

=== Adult film industry === In 2012 proponents gathered 372,000 voter signatures through a citizens' initiative in Los Angeles County to put Measure B on the 2012 ballot. As a result, Measure B, a law requiring the use of condoms in the production of pornographic films, was passed. This requirement has received much criticism and is said by some to be counter-productive, merely forcing companies that make pornographic films to relocate to other places without this requirement. Producers claim that condom use depresses sales.

=== Sex education === Condoms are often used in sex education programs, because they have the capability to reduce the chances of pregnancy and the spread of some sexually transmitted infections when used correctly. A recent American Psychological Association (APA) press release supported the inclusion of information about condoms in sex education, saying "comprehensive sexuality education programs ... discuss the appropriate use of condoms", and "promote condom use for those who are sexually active." In the United States, teaching about condoms in public schools is opposed by some religious organizations. Planned Parenthood, which advocates family planning and sex education, argues that no studies have shown abstinence-only programs to result in delayed intercourse, and cites surveys showing that 76% of American parents want their children to receive comprehensive sexuality education including condom use.

=== Infertility treatment === Common procedures in infertility treatment such as semen analysis and intrauterine insemination (IUI) require collection of semen samples. These are most commonly obtained through masturbation, but an alternative to masturbation is use of a special collection condom to collect semen during sexual intercourse. Collection condoms are made from silicone or polyurethane, as latex is somewhat harmful to sperm. Some religions prohibit masturbation entirely. Also, compared with samples obtained from masturbation, semen samples from collection condoms have higher total sperm counts, sperm motility, and percentage of sperm with normal morphology. For this reason, they are believed to give more accurate results when used for semen analysis, and to improve the chances of pregnancy when used in procedures such as intracervical or intrauterine insemination. Adherents of religions that prohibit contraception, such as Catholicism, may use collection condoms with holes pricked in them. For fertility treatments, a collection condom may be used to collect semen during sexual intercourse where the semen is provided by the woman's partner. Private sperm donors may also use a collection condom to obtain samples through masturbation or by sexual intercourse with a partner and will transfer the ejaculate from the collection condom to a specially designed container. The sperm is transported in such containers, in the case of a donor, to a recipient woman to be used for insemination, and in the case of a woman's partner, to a fertility clinic for processing and use. However, transportation may reduce the fecundity of the sperm. Collection condoms may also be used where semen is produced at a sperm bank or fertility clinic. Condom therapy is sometimes prescribed to infertile couples when the female has high levels of antisperm antibodies. The theory is that preventing exposure to her partner's semen will lower her level of antisperm antibodies, and thus increase her chances of pregnancy when condom therapy is discontinued. However, condom therapy has not been shown to increase subsequent pregnancy rates.

=== Other uses ===

Condoms excel as multipurpose containers and barriers because they are waterproof, elastic, durable, and (for military and espionage uses) will not arouse suspicion if found. Ongoing military utilization began during World War II, and includes covering the muzzles of rifle barrels to prevent fouling, the waterproofing of firing assemblies in underwater demolitions, and storage of corrosive materials and garrotes by paramilitary agencies. Condoms have also been used to smuggle alcohol, cocaine, heroin, and other drugs across borders and into prisons by filling the condom with drugs, tying it in a knot and then either swallowing it or inserting it into the rectum. These methods are very dangerous and potentially lethal; if the condom breaks, the drugs inside become absorbed into the bloodstream and can cause an overdose. Medically, condoms can be used to cover endovaginal ultrasound probes, or in field chest needle decompressions they can be used to make a one-way valve. Condoms have also been used to protect scientific samples from the environment, and to waterproof microphones for underwater recording.

== Types == Most condoms have a reservoir tip or teat end, making it easier to accommodate the man's ejaculate. Condoms come in different sizes and shapes. They also come in a variety of surfaces intended to stimulate the user's partner. Condoms are usually supplied with a lubricant coating to facilitate penetration, while flavored condoms are principally used for oral sex. As mentioned above, most condoms are made of latex, but polyurethane and lambskin condoms also exist.

=== Internal condom ===

External condoms have a tight ring to form a seal around the penis, while internal condoms usually have a large stiff ring to prevent them from slipping into the body orifice. The Female Health Company produced an internal condom that was initially made of polyurethane, but newer versions are made of nitrile rubber. Medtech Products produces an internal condom made of latex.

=== Materials ===

==== Natural latex ====

Latex has outstanding elastic properties: Its tensile strength exceeds 30 MPa, and latex condoms may be stretched in excess of 800% before breaking. In 1990 the ISO set standards for condom production (ISO 4074, Natural latex rubber condoms), and the EU followed suit with its CEN standard (Directive 93/42/EEC concerning medical devices). Every latex condom is tested for holes with an electric current. If the condom passes, it is rolled and packaged. In addition, a portion of each batch of condoms is subject to water leak and air burst testing. effeffectWhile the advantages of latex have made it the most popular condom material, it does have some drawbacks. Latex condoms are damaged when used with oil-based substances as lubricants, such as petroleum jelly, cooking oil, baby oil, mineral oil, skin lotions, suntan lotions, cold creams, butter or margarine. Contact with oil makes latex condoms more likely to break or slip off due to loss of elasticity caused by the oils. Additionally, latex allergy precludes use of latex condoms and is one of the principal reasons for the use of other materials. In May 2009, the U.S. Food and Drug Administration (FDA) granted approval for the production of condoms composed of Vytex, latex that has been treated to remove 90% of the proteins responsible for allergic reactions. An allergen-free condom made of synthetic latex (polyisoprene) is also available.

==== Synthetic ==== The most common non-latex condoms are made from polyurethane. Condoms may also be made from other synthetic materials, such as AT-10 resin, and most polyisoprene. Polyurethane condoms tend to be the same width and thickness as latex condoms, with most polyurethane condoms between 0.04 mm and 0.07 mm thick. Polyurethane can be considered better than latex in several ways: it conducts heat better than latex, is not as sensitive to temperature and ultraviolet light (and so has less rigid storage requirements and a longer shelf life), can be used with oil-based lubricants, is less allergenic than latex, and does not have an odor. Polyurethane condoms have gained FDA approval for sale in the United States as an effective method of contraception and HIV prevention, and under laboratory conditions have been shown to be just as effective as latex for these purposes. However, polyurethane condoms are less elastic than latex ones, and may be more likely to slip or break than latex, lose their shape or bunch up more than latex, and are more expensive. Polyisoprene is a synthetic version of natural rubber latex. While significantly more expensive, it has the advantages of latex (such as being softer and more elastic than polyurethane condoms) without the protein which is responsible for latex allergies. Unlike polyurethane condoms, they cannot be used with an oil-based lubricant.

==== Lambskin ==== Condoms made from the intestines of sheep, labeled "lambskin", are also available. Although they are generally effective as a contraceptive by blocking sperm, studies have found that they are less effective than latex in preventing the transmission of sexually transmitted infections because of pores in the material. This is because intestines, by their nature, are porous, permeable membranes, and while sperm are too large to pass through the pores, viruses—such as HIV, herpes, and genital warts—are small enough to pass. As a result of laboratory data on condom porosity, in 1989, the FDA began requiring lambskin condom manufacturers to indicate that the products were not to be used for the prevention of sexually transmitted infections. The FDA cautions that while lambskin condoms "provide good birth control and a varying degree of protection against some, but not all, sexually transmitted diseases", people do not know what STIs a partner might have, and thus cannot assume that a lambskin condom will protect them. While lambskin condoms avoid triggering latex allergies, polyurethane condoms do as well, while also protecting more reliably against STIs. As slaughter by-products, lambskin condoms are also not vegetarian. Pharmacist advice prepared by the Canadian Pharmaceutical Journal says that lambskin condoms "are generally not recommended" due to limited STI prevention. An article in Adolescent Medicine advises that they "should be used only for pregnancy prevention".

=== Spermicide === Some latex condoms are lubricated at the manufacturer with a small amount of a nonoxynol-9, a spermicidal chemical. According to Consumer Reports, condoms lubricated with spermicide have no additional benefit in preventing pregnancy, have a shorter shelf life, and may cause urinary tract infections in women. In contrast, application of separately packaged spermicide is believed to increase the contraceptive efficacy of condoms. Nonoxynol-9 was once believed to offer additional protection against STIs (including HIV) but recent studies have shown that, with frequent use, nonoxynol-9 may increase the risk of HIV transmission. The World Health Organization says that spermicidally lubricated condoms should no longer be promoted. However, it recommends using a nonoxynol-9 lubricated condom over no condom at all. As of 2005, nine condom manufacturers have stopped manufacturing condoms with nonoxynol-9 and Planned Parenthood has discontinued the distribution of condoms so lubricated.

=== Ribbed and studded ===

Textured condoms include studded and ribbed condoms which can provide extra sensations to both partners. The studs or ribs can be located on the inside, outside, or both; alternatively, they are located in specific sections to provide directed stimulation to either the G-spot or frenulum. Many textured condoms which advertise "mutual pleasure" also are bulb-shaped at the top, to provide extra stimulation to the penis. Some women experience irritation during vaginal intercourse with studded condoms.

=== Flavored === Flavored condoms are specialized condom products that have a flavor-coating and that are specially designed for an oral intercourse exclusively, and not for penetrative acts. Originally flavored condoms used to be more of a novelty item, rather than for actual protection. However, now there are FDA approved flavored condoms on the market. Some flavored condoms also have a flavor-specific scent added to them. Some concerns of using flavored condoms in vaginal penetration exist, since flavored condoms have some amounts of sugar on them, and inserting sugar to vagina can end up resulting in candidal vulvovaginitis or bacterial vaginosis. People with latex allergy should avoid using flavored latex-material condoms, and instead use polyurethane or polyisoprene condoms.

=== Other === The anti-rape condom is another variation designed to be worn by women. It is designed to cause pain to the attacker, hopefully allowing the victim a chance to escape. A collection condom is used to collect semen for fertility treatments or sperm analysis. These condoms are designed to maximize sperm life. In February 2022, the U.S. Food and Drug Administration (FDA) approved the first condoms specifically indicated to help reduce transmission of sexually transmitted infections (STIs) during anal intercourse.

== Prevalence ==

The prevalence of condom use varies greatly between countries. Most surveys of contraceptive use are among married women, or women in informal unions. Japan has the highest rate of condom usage in the world: in that country, condoms account for almost 80% of contraceptive use by married women. On average, in developed countries, condoms are the most popular method of birth control: 28% of married contraceptive users rely on condoms. In the average less-developed country, condoms are less common: only 6–8% of married contraceptive users choose condoms.

== History ==

=== Before the 19th century === Whether condoms were used in ancient civilizations is debated by archaeologists and historians. In ancient Egypt, Greece, and Rome, pregnancy prevention was generally seen as a woman's responsibility, and the only well documented contraception methods were female-controlled devices. In Asia before the 15th century, some use of glans condoms (devices covering only the head of the penis) is recorded. Condoms seem to have been used for contraception, and to have been known only by members of the upper classes. In China, glans condoms may have been made of oiled silk paper, or of lamb intestines. In Japan, condoms called Kabuto-gata (甲形) were made of tortoise shell or animal horn.

In 16th-century Italy, anatomist and physician Gabriele Falloppio wrote a treatise on syphilis. The earliest documented strain of syphilis, first appearing in Europe in a 1490s outbreak, caused severe symptoms and often death within a few months of contracting the disease. Falloppio's treatise is the earliest uncontested description of condom use: it describes linen sheaths soaked in a chemical solution and allowed to dry before use. The cloths he described were sized to cover the glans of the penis, and were held on with a ribbon. Falloppio claimed that an experimental trial of the linen sheath demonstrated protection against syphilis. After this, the use of penis coverings to protect from disease is described in a wide variety of literature throughout Europe. The first indication that these devices were used for birth control, rather than disease prevention, is the 1605 theological publication De iustitia et iure (On justice and law) by Catholic theologian Leonardus Lessius, who condemned them as immoral. In 1666, the English Birth Rate Commission attributed a recent downward fertility rate to use of "condons", the first documented use of that word or any similar spelling. Other early spellings include "condam" and "quondam", from which the Italian derivation guantone has been suggested, from guanto, "a glove".

In addition to linen, condoms during the Renaissance were made out of intestines and bladder. In the late 16th century, Dutch traders introduced condoms made from "fine leather" to Japan. Unlike the horn condoms used previously, these leather condoms covered the entire penis.

Casanova in the 18th century was one of the first reported using "assurance caps" to prevent impregnating his mistresses. From at least the 18th century, condom use was opposed in some legal, religious, and medical circles for essentially the same reasons that are given today: condoms reduce the likelihood of pregnancy, which some thought immoral or undesirable for the nation; they do not provide full protection against sexually transmitted infections, while belief in their protective powers was thought to encourage sexual promiscuity; and, they are not used consistently due to inconvenience, expense, or loss of sensation. Despite some opposition, the condom market grew rapidly. In the 18th century, condoms were available in a variety of qualities and sizes, made from either linen treated with chemicals, or "skin" (bladder or intestine softened by treatment with sulfur and lye). They were sold at pubs, barbershops, chemist shops, open-air markets, and at the theater throughout Europe and Russia. They later spread to America, although in every place there were generally used only by the middle and upper classes, due to both expense and lack of sex education.

=== 1800 through 1920s ===

The early 19th century saw contraceptives promoted to the poorer classes for the first time. Writers on contraception tended to prefer other birth control methods to the condom. By the late 19th century, many feminists expressed distrust of the condom as a contraceptive, as its use was controlled and decided upon by men alone. They advocated instead for methods controlled by women, such as diaphragms and spermicidal douches. Other writers cited both the expense of condoms and their unreliability (they were often riddled with holes and often fell off or tore). Still, they discussed condoms as a good option for some and the only contraceptive that protects from disease. Many countries passed laws impeding the manufacture and promotion of contraceptives. In spite of these restrictions, condoms were promoted by traveling lecturers and in newspaper advertisements, using euphemisms in places where such ads were illegal. Instructions on how to make condoms at home were distributed in the United States and Europe. Despite social and legal opposition, at the end of the 19th century the condom was the Western world's most popular birth control method.

Beginning in the second half of the 19th century, American rates of sexually transmitted infections skyrocketed. Causes cited by historians include the effects of the American Civil War and the ignorance of prevention methods promoted by the Comstock laws. To fight the growing epidemic, sex education classes were introduced to public schools for the first time, teaching about venereal diseases and how they were transmitted. They generally taught abstinence was the only way to avoid sexually transmitted infections. Condoms were not promoted for disease prevention because the medical community and moral watchdogs considered STIs to be punishment for sexual misbehavior. The stigma against people with these diseases was so significant that many hospitals refused to treat people with syphilis.

The German military was the first to promote condom use among its soldiers in the later 19th century. Early 20th century experiments by the American military concluded that providing condoms to soldiers significantly lowered rates of sexually transmitted infections. During World War I, the United States and (at the beginning of the war only) Britain were the only countries with soldiers in Europe who did not provide condoms and promote their use. In the decades after World War I, there remained social and legal obstacles to condom use throughout the U.S. and Europe. Founder of psychoanalysis Sigmund Freud opposed all methods of birth control because their failure rates were too high. Freud was especially opposed to the condom because he thought it cut down on sexual pleasure. Some feminists continued to oppose male-controlled contraceptives such as condoms. In 1920 the Church of England's Lambeth Conference condemned all "unnatural means of conception avoidance". The Bishop of London, Arthur Winnington-Ingram, complained of the huge number of condoms discarded in alleyways and parks, especially after weekends and holidays. However, European militaries continued to provide condoms to their members for disease protection, even in countries where they were illegal for the general population. Through the 1920s, catchy names and slick packaging became an increasingly important marketing technique for many consumer items, including condoms and cigarettes. Quality testing became more common, involving filling each condom with air followed by one of several methods intended to detect loss of pressure. Worldwide, condom sales doubled in the 1920s.

=== Rubber and manufacturing advances === In 1839, Charles Goodyear discovered a way of processing natural rubber, which is too stiff when cold and too soft when warm, in such a way as to make it elastic. This proved to have advantages for the manufacture of condoms; unlike the sheep's gut condoms, they could stretch and did not tear quickly when used. The rubber vulcanization process was patented by Goodyear in 1844. The first rubber condom was produced in 1855. The earliest rubber condoms had a seam and were as thick as a bicycle inner tube. Besides this type, small rubber condoms covering only the glans were often used in England and the United States. There was more risk of losing them and if the rubber ring was too tight, it would constrict the penis. This type of condom was the original "capote" (French for condom), perhaps because of its resemblance to a woman's bonnet worn at that time, also called a capote. For many decades, rubber condoms were manufactured by wrapping strips of raw rubber around penis-shaped molds, then dipping the wrapped molds in a chemical solution to cure the rubber. In 1912, Polish-born inventor Julius Fromm developed a new, improved manufacturing technique for condoms: dipping glass molds into a raw rubber solution. Called cement dipping, this method required adding gasoline or benzene to the rubber to make it liquid. Around 1920 patent lawyer and vice-president of the United States Rubber Company Ernest Hopkinson invented a new technique of converting latex into rubber without a coagulant (demulsifier), which featured using water as a solvent and warm air to dry the solution, as well as optionally preserving liquid latex with ammonia. Condoms made this way, commonly called "latex" ones, required less labor to produce than cement-dipped rubber condoms, which had to be smoothed by rubbing and trimming. The use of water to suspend the rubber instead of gasoline and benzene eliminated the fire hazard previously associated with all condom factories. Latex condoms also performed better for the consumer: they were stronger and thinner than rubber condoms, and had a shelf life of five years (compared to three months for rubber). Until the twenties, all condoms were individually hand-dipped by semi-skilled workers. Throughout the decade of the 1920s, advances in the automation of the condom assembly line were made. The first fully automated line was patented in 1930. Major condom manufacturers bought or leased conveyor systems, and small manufacturers were driven out of business. The skin condom, now significantly more expensive than the latex variety, became restricted to a niche high-end market.

=== 1930 to present ===

In 1930 the Anglican Church's Lambeth Conference sanctioned the use of birth control by married couples. In 1931 the Federal Council of Churches in the U.S. issued a similar statement. The Roman Catholic Church responded by issuing the encyclical Casti connubii affirming its opposition to all contraceptives, a stance it has never reversed. In the 1930s, legal restrictions on condoms began to be relaxed. However, during this period Fascist Italy and Nazi Germany increased restrictions on condoms (limited sales as disease preventatives were still allowed). During the Depression, condom lines by Schmid gained in popularity. Schmid still used the cement-dipping method of manufacture which had two advantages over the latex variety. Firstly, cement-dipped condoms could be safely used with oil-based lubricants. Secondly, while less comfortable, these older-style rubber condoms could be reused and so were more economical, a valued feature in hard times. More attention was brought to quality issues in the 1930s, and the U.S. Food and Drug Administration began to regulate the quality of condoms sold in the United States. Throughout World War II, condoms were not only distributed to male U.S. military members, but also heavily promoted with films, posters, and lectures. European and Asian militaries on both sides of the conflict also provided condoms to their troops throughout the war, even Germany which outlawed all civilian use of condoms in 1941. In part because condoms were readily available, soldiers found a number of non-sexual uses for the devices, many of which continue to this day. After the war, condom sales continued to grow. From 1955 to 1965, 42% of Americans of reproductive age relied on condoms for birth control. In Britain from 1950 to 1960, 60% of married couples used condoms. The birth control pill became the world's most popular method of birth control in the years after its 1960 début, but condoms remained a strong second. The U.S. Agency for International Development pushed condom use in developing countries to help solve the "world population crises": by 1970 hundreds of millions of condoms were being used each year in India alone.(This number has grown in recent decades: in 2004, the government of India purchased 1.9 billion condoms for distribution at family planning clinics.)

In the 1960s and 1970s quality regulations tightened, and more legal barriers to condom use were removed. In Ireland, legal condom sales were allowed for the first time in 1978. Advertising, however was one area that continued to have legal restrictions. In the late 1950s, the American National Association of Broadcasters banned condom advertisements from national television; this policy remained in place until 1979. After it was discovered in the early 1980s that AIDS can be a sexually transmitted infection, the use of condoms was encouraged to prevent transmission of HIV. Despite opposition by some political, religious, and other figures, national condom promotion campaigns occurred in the U.S. and Europe. These campaigns increased condom use significantly. Due to increased demand and greater social acceptance, condoms began to be sold in a wider variety of retail outlets, including in supermarkets and in discount department stores such as Walmart. Condom sales increased every year until 1994, when media attention to the AIDS pandemic began to decline. The phenomenon of decreasing use of condoms as disease preventatives has been called prevention fatigue or condom fatigue. Observers have cited condom fatigue in both Europe and North America. As one response, manufacturers have changed the tone of their advertisements from scary to humorous. New developments continued to occur in the condom market, with the first polyurethane condom—branded Avanti and produced by the manufacturer of Durex—introduced in the 1990s. Worldwide condom use is expected to continue to grow: one study predicted that developing nations would need 18.6 billion condoms by 2015. As of September 2013, condoms